Mesothelioma patients who are not yet having significant symptoms may want to hold off on surgery to remove their diseased pleura. Thoracic surgeons and cancer specialists at the University of Chicago reached that conclusion after analyzing the cases of 36 mesothelioma patients with varying degrees of illness severity who underwent extended pleurectomy with decortication (EPD).
EPD involves removing not only the pleural membrane around the lung where mesothelioma tumors start, but also other at-risk tissues and any additional tumors that are growing inside the chest cavity. The goal of the current study was to determine how EPD affects both health-related quality of life and pulmonary function in mesothelioma patients.
Of the enrolled mesothelioma patients, 17 had a performance status (PS) of 0 before surgery, meaning that their overall health was good and their symptoms were minimal. The remaining 19 patients had a PS of 1 or 2, indicating that their overall health was not as good and their mesothelioma symptoms were more severe.
Although EPD did appear to improve the quality of life for mesothelioma patients in the PS1 and PS2 groups, those who started out at PS0 actually felt worse after surgery. For these patients, measures of lung function including forced vital capacity, forced expiratory volume in 1 second, total lung capacity, and diffusing capacity of the lung for carbon monoxide all significantly decreased after surgery. Not surprisingly, these decreases also impacted their quality of life.
“Extended pleurectomy and decortication did not improve overall health-related quality of life and had a negative impact on pulmonary function in minimally symptomatic patients,” writes lead author David Burkholder, BS, with the Division of Cardiac and Thoracic Surgery.
The good news is that mesothelioma patients who started out with a worse performance status saw significant improvements in their quality of life and continued to improve as long as 7 or 8 months after surgery. Although the pulmonary function for these mesothelioma patients did not appear to be effected by EPD, the authors speculate that EPD may have improved their quality of life by temporarily stopping the gradual decline in lung function that they had been experiencing.
The new research appears in the Annals of Thoracic Surgery.
Burkholder, D et al, “Effects of Extended Pleurectomy and Decortication on Quality of Life and Pulmonary Function in Patients with Malignant Pleural Mesothelioma:, March 28, 2015, Annals of Thoracic Surgery, Epub ahead of print